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Diabetes case studies for nurses

The Community Preventive Services Task Force (CPSTF) recommends diabetes case management strategies on the basis of strong evidence of effectiveness in improving glycemic control. There also is sufficient evidence of improved provider monitoring of glycated hemoglobin (GHb) when case management was delivered in combination .

#1 Diabetes case studies for nurses

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The patient is a year-old man who has had type 1 diabetes for 15 years. The patient reports that he is currently homeless and Christians and sex leadership journal lost his supply of insulin, syringes, glucose meter, and related glucose testing supplies. He reports that he has been on insulin since the time of his diagnosis, and he has never been prescribed oral agents for diabetes management. GAD antibodies were positive, and C-peptide value was low, helping to confirm the diagnosis of type 1 diabetes. Most recently, he has been using insulin glargine 55 units once daily, and insulin aspart per correction doses 3 times daily. There was an imbalance when comparing his basal and bolus insulin doses. When asked about meal doses of insulin aspart, the patient relates that he is currently homeless and eats when food is available, often snacking on bits of food throughout the day. He was not using a meal dose of insulin aspart, but he would use this insulin to correct for hyperglycemia. The patient has had previous episodes of diabetic ketoacidosis, for which he was hospitalized. With this episode of hyperglycemia, he is not experiencing any nausea, vomiting, or abdominal discomfort, and he appears well. The patient has no recent concerns for hypoglycemia. He reports that with past episodes of hypoglycemia, he experienced sweatiness and shakiness, for which he treated with juice or food. Page 1 of 2 1 2 Recommended for you Related Articles Depression among diabetes Diabetes case studies for nurses may affect long-term drug adherence Cardiometabolic Disease Staging score calculates diabetes risk in obese individuals Some antidiabetic agents may increase pneumonia risk in Diabetes case studies for nurses 2 diabetes Related Topics Bipolar Disorder Diabetes Type 1 Diabetes Related Links Diabetes Information Center You must be a registered member of Clinical Advisor to post Diabetes case studies for nurses comment. Purple Fingertips in an Elderly Woman An elderly woman with a history of hypertension and metastatic bladder cancer presents to the ED with bilateral finger pain and cyanosis associated with a lb weight loss. A year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior. A year-old man with chronic obstructive pulmonary disease reports having some mild chest pain. Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes. The patient presented to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days. History of present illness The patient is a year-old man who has had type 1 diabetes for 15 years. Laboratory values on admission A1c: Related Articles Chelten hills model trains among diabetes patients may affect long-term drug adherence Cardiometabolic Disease Staging score calculates diabetes risk in obese individuals Some antidiabetic agents may increase pneumonia risk in type 2 diabetes. Related Links Diabetes Information Center. You must be a registered member of Clinical Advisor to post a comment. Fever and low platelets. More in...

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The specialized role of nursing in the care and education of people with diabetes has been in existence for more than 30 years. Diabetes education carried out by nurses has moved beyond the hospital bedside into a variety of health care settings. Among the disciplines involved in diabetes education, nursing has played a pivotal role in the diabetes team management concept. This was well illustrated in the Diabetes Control and Complications Trial DCCT by the effectiveness of nurse managers in coordinating and delivering diabetes self-management education. These nurse managers not only performed administrative tasks crucial to the outcomes of the DCCT, but also participated directly in patient care. The emergence and subsequent growth of advanced practice in nursing during the past 20 years has expanded the direct care component, incorporating aspects of both nursing and medical care while maintaining the teaching and counseling roles. Both the clinical nurse specialist CNS and nurse practitioner NP models, when applied to chronic disease management, create enhanced patient-provider relationships in which self-care education and counseling is provided within the context of disease state management. Clement 2 commented in a review of diabetes self-management education issues that unless ongoing management is part of an education program, knowledge may increase but most clinical outcomes only minimally improve. Advanced practice nurses by the very nature of their scope of practice effectively combine both education and management into their delivery of care. At the completion of assessments, advanced practice nurses, in conjunction with patients, identify management goals and determine appropriate plans of care. Many advanced practice nurses NPs, CNSs, nurse midwives, and nurse anesthetists may prescribe and adjust medication through prescriptive authority granted to them by their state nursing regulatory body. Currently, all 50 states have some form of prescriptive authority for advanced practice nurses. It is a crucial component in the care of people with type 1 diabetes, and it becomes increasingly important in the care of patients with type 2 diabetes who have a constellation of comorbidities, all of which must be managed for successful disease outcomes. Many studies have documented the effectiveness of advanced practice nurses in managing common primary care issues. In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes, 5 in specialized diabetes foot care programs, 6 in the management of diabetes in pregnancy, 7 and in the care of pediatric...

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Doug is 47 year old man admitted to your medical unit with an ulceration on his right foot. His blood glucose level is What is the normal range for blood glucose? For example, if Doug was keeping his glucose level in the normal range, but something in his routine changed that effected the action of his insulin i. Chart the action of his insulin throughout the day, showing where the insulin was given and where it peaks. Based on your nursing assessment, what do you suspect? How would you confirm your suspicions? It is likely that Doug is experiencing hypoglycemia. The signs and symptoms of hypoglycemia include headache and sweating. If He remains conscious, Doug should swallow about 15 grams of carbohydrate, such as 4oz of fruit juice, 2 sugar cubes, or a commercial glucose product. If He loses consciousness before the carbohydrate can be swallowed, then glucose or glucagon must be given parenterally. After the immediate hypoglycemic crisis is treated, Doug should be given a meal or snack to prevent secondary hypoglycemia. His insulin regimen and routine should also be evaluated in order to prevent hypoglycemia from occurring in the future. The hypoglycemia occurred at 4pm because of the combined effects of his R-insulin and N-insulin. The effect of the R-insulin He took before lunch was beginning to decline but were still relatively strong. In addition, the effect of the N-insulin taken in the morning was beginning to peak. The combination of both of these insulin effects caused the body to move too much glucose from the blood stream into body cells, which led to the hypoglycemia. What do you do? Thisefore, the next step would be to skip the dose of R-insulin before dinner, document the reason why, and continue to monitor his glucose levels. It would probably be a good idea to also inform the doctor that this step has been taken. If the next dose of insulin were given despite the already low glucose levels, then Doug would be at risk to experience another hypoglycemic reaction. It is important to make sure that you are...

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An year-old Caucasian female presents to the office for a follow-up visit after routine blood work 2 weeks earlier showed a progressively increasing A1C level. A year-old Chinese American female presents to her primary care provider for her 3-month routine diabetes follow-up. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. Antecedent hypoglycemia impairs autonomic cardiovascular function: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Continuous glucose monitoring in non-insulin-using individuals with type 2 diabetes: Feasibility and acceptability of continuous glucose monitoring and accelerometer technology in exercising individuals with type 2 diabetes. Assuring the accuracy of home glucose monitoring. J Am Board Fam Pract. American Association of Diabetes Educators. Guidelines for Successful Outcomes. Accessed October 13, Standards of medical care in diabetes The prevalence of comorbid depression in adults with diabetes: Diabetes meanings among those without diabetes: Eye disease in Latinos: Insulin pen use for type 2 diabetes: Identifying variables associated with inaccurate self-monitoring of blood glucose: Bhattacharya SM, Ghosh M. Insulin resistance and adolescent girls with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. Insulin pump use in type 2 diabetes. Comparison of a multiple daily insulin injection regimen basal once-daily glargine plus mealtime lispro and continuous subcutaneous insulin infusion lispro in type 1 diabetes: The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Acanthosis nigricans identifies youth at high risk for metabolic abnormalities. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Effect of intensive compared with standard glycemia treatment strategies on mortality by baseline subgroup characteristics: Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood...

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These pages are best viewed with Netscape version 3. When viewed with other browsers, some characters or attributes may not be rendered correctly. Presentation A year-old woman with obesity and a 9year history of type 2 diabetes presents with complaints of fatigue, difficulty losing weight, and no motivation. She denies polyuria, polydipsia, polyphagia, blurred vision, or vaginal infections. She notes a marked decrease in her energy level, particularly in the afternoons. She is tearful and states that she was diagnosed with depression and prescribed an antidepressant that she chose not to take. She states that she has gained an enormnous amount of weight since being placed on insulin 6 years ago. Her weight has continued to increase over the past 5 years, and she is presently at the highest weight she has ever been. She states that every time she tries to cut down on her eating she has symptoms of shakiness, diaphoresis, and increased hunger. She does not follow any specific diet and has been so fearful of hypoglycemia that she often eats extra snacks. Her health care practitioners have repeatedly advised weight loss and exercise to improve her health status. She complains that the pain in her knees and ankles makes it difficult to do any exercise. This dose was recently increased after her HbA 1c , was found to be 8. Past medical history is remarkable for hypertension, hypertfiglyceridemia, and arthritis. Current medications include only insulin, lisinopril Prinivil , and hydrochlorthiazide Dyazide with triarnterene. The remainder of the physical exam is unremarkable. On laboratory testing, chemistries, BUN, creatinine, and liver function tests are normal. Thyroid function tests and urine microalburnin are also normal. After an explanation that the increasing insulin doses were contributing to her weight gain and that she would need to decrease her insulin dose...

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Diabetes case studies for nurses

Case 1: John

The patient presented to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient is a year-old man who has had type 1 diabetes for 15 years. He presents to the emergency room with hyperglycemia and concern for. THE COMPETITION FOR THIS CASE STUDY IS NOW CLOSED. This year- old Type 1 Diabetic was found unconscious, lying on his. Helen Noble Lecturer, Health Services Research, School of Nursing and Midwifery, The case study is based on a patient with diabetes who was admitted to. Case Study: A Year-Old Woman With Obesity, Poorly Controlled Type 2 Diabetes, and Symptoms of Depression. Marjorie Cypress, MS, C-ANP, CDE. Nursing students frequently have difficulty understanding diabetes mellitus and other chronic illnesses. Using the active learning technique of the case study.

Session 6 - Case Study Diabetes Complication ( Dr/ Heba Mady )

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